'Patients are still dying'

A complaint leads to a national uproar and the fall of a Presidential Cabinet secretary

After laboring in relative obscurity as a doctor in the Phoenix VA Health Care System, Dr. Sam Foote just wanted to put a stop to deaths and delayed care at the Phoenix hospital.

He had no idea that when he filed a complaint with the VA Office of the Inspector General late last year it would lead to nationwide investigations, congressional hearings, presidential speeches and the resignation of a Cabinet secretary.

But all of that transpired in just seven weeks, and the fallout continues this weekend as Foote makes the rounds of network news shows in the aftermath of President Barack Obama's announcement Friday that he accepted VA Secretary Eric Shinseki's resignation.

"I'd rather not be in the media spotlight," the 61-year-old Paradise Valley resident said in an interview with The Arizona Republic on Friday. "I wish it was just 15 minutes of fame. I'm praying now it's not 15 months."

Foote, a doctor of internal medicine, grew up in Los Angeles, graduated from UCLA and earned his medical degree at Hahnemann Medical College, now part of Drexel University, in Philadelphia.

The story of his transformation into a news figure began in late 2012, when he started to suspect that Arizona veterans werebeing short-changed on medical care. As more patients enrolled in the VA system, physicians worked overtime to address the increased workload and backlog.

The stress caused an exodus of medical practitioners, which magnified the caseloads. New patients were forced to wait more than a year for initial appointments, and those seeking specialist care also faced prolonged delays.

Just as troubling, Foote said, doctors and nurses were under such a strain that medical mistakes became more likely.

At the same time, Foote said, VA administrators were earning promotions and bonus pay by issuing reports that said patient access had improved dramatically. He said he realized the data on wait times was falsified.

In August of last year, a colleague told him that scheduling clerks who made calls for appointment reminders had been informed at least 10 times that the patients already were dead.

"That was the epiphany," Foote said. "It was more than massaging the numbers. There were real consequences here. ... I started asking questions."

Dr. Sam Foote has emerged as the iconic whistle-blower in America's angst over health care for veterans.

(Photo: David Wallace/The Republic)

'They started coming after me'

Phoenix VA 'cooking the books'; Foote goes public

Foote said he learned over time that the Phoenix VA was "cooking the books" in a variety of ways. He said he learned of more veterans who died, and he raised concerns about specific heart and diabetes patients during a staff meeting, but was brushed off.

He said he did not trust Sharon Helman, the Phoenix VA Health Care System director. Helman, who was suspended in May, had implemented the agency's Wildly Important Goals program, which made cutting wait times the No. 1 priority. And, Foote said, he'd seen other employees face retaliation when they tried to expose misconduct.

Foote said he was familiar with the VA Office of Inspector General. In 2011, he had lodged a complaint against then-Phoenix system Director Gabriel Perez, who abruptly resigned amid the ensuing investigation.

In early 2013, Foote lodged a complaint against another executive, but this time, he said, "They started coming after me."

Hours and caseloads increased, and Foote said he began to feel harassed.

A planned 2015 retirement no longer seemed possible. He set a new date of Dec. 31, 2013.

By October, Foote said, he had gathered information for an OIG complaint alleging that up to 40 veterans died while awaiting care in the Phoenix VA system. He described several ways that patient-appointment records were falsified, concealed or deleted, and he blamed the bonus system as a motivating factor.

An OIG team was sent to Phoenix from San Diego in December, and it began investigating.

About the same time, Foote said, he became convinced the Arizona phenomenon was not isolated, and the public should be told what was going on. He contacted The Arizona Republic and agreed to cooperate with the newspaper on an investigative project. Foote's role would remain confidential until his Dec. 31 retirement. He also wanted to delay the story to give OIG investigators time to address the Phoenix problems.

In early February, Foote said, he asked former Maricopa County Attorney Rick Romley for advice. Romley is a U.S. Marine Corps veteran who lost both legs above the knee to a land mine during the Vietnam War and is an activist for veterans. Romley told him, "You need to go national."

That month, Foote mailed a second letter to the inspector general with copies to Sen. John McCain, R-Ariz., Rep. Ann Kirkpatrick, D-Ariz., and the U.S. Attorney's Office.

"Patients are still dying," the letter alleged. "How can that be three months after I first ­notified you of the problem?"

Foote said he got no response from U.S. Attorney John Leonardo and heard back from Kirkpatrick's office after he began working with another member of Congress. He said he heard from Tom McCanna, McCain's aide responsible for veterans affairs. "He took the information, but my impression was he wasn't going to be moving on it anytime soon." (McCain's office has declined to discuss service to specific constituents without a signed release form, or to allow McCanna to be interviewed about his work.)

Dr. Katherine Mitchell, a current physician at the VA, is another whistle-blower who corroborated much of Dr. Sam Foote's information(Photo: Nick Oza/The Republic)

The Republic, meanwhile, located additional whistle-blowers, including Dr. Katherine Mitchell, a current physician at the VA who corroborated much of Foote's information. A reporter interviewed the family of a veteran who died awaiting care and sought ­documentation to verify Foote's allegations. The newspaper's records request submitted under the Freedom of Information Act was stonewalled, and to this day, the Department of Veterans Affairs has failed to provide a single responsive document.

Foote said he became increasingly frustrated, but he finally made contact with Eric Hannel, staff director for an oversight subcommittee of the House Committee on Veterans' Affairs. From that moment, Foote said, his complaint gained traction as congressional investigators under Rep. Jeff Miller, R-Fla., the committee chairman, began digging deeper.

"He's a very bright guy who's not to be messed with," Foote said. "And he's so on the side of veterans. I knew I was in the right place, and this was not going to be pushed aside."

Foote said he also knew that The Republic had developed extensive information and was preparing an article. He turned to CNN in hopes of national television coverage. Foote said the network was eager to work the story, but it was preoccupied with the disappearance of Malaysia Airlines Flight 370.

Rep. Jeff Miller, R-Fla., and chairman of the House Committee on Veterans' Affairs, made a stunning announcement during an April 9 committee hearing.

(Photo: AP Photo)

A stunning announcement

The story goes viral and ends a high-profile career

The waiting ended April 9. During a House Veterans' Affairs Committee hearing, Miller announced evidence showing VA officials were falsifying records of care for veterans in Arizona. Then he stunned colleagues and the audience with an additional statement:

"It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care."

The April 10 Republic story quoted Miller, broke the news of Foote's accusations and included comments by San Tan Valley resident Sally Eliano, who described how her father-in-law died of cancer after prolonged waits for VA doctor appointments.

"They (VA administrators) just don't respect any rules at all," Foote told The Republic in that article. "They just don't care. ... They beat me to the ground. I retired just exactly so I could do this."

Foote says he was inundated with interview requests from Arizona media. He spoke to reporters off camera because of his agreement to let CNN do the first TV interview.

"That was part of a deal that was struck," he explained. "I was very aware of the media and how the game is played. Political savvy is what I lacked. Rick Romley was able to assist me."

On April 23, CNN broadcast an interview with Foote.

He told the network that the hospital had a sham list showing the VA was providing timely medical appointments within 14 days, the goal that had been set by the department nationally.

"The only record that you have ever been there requesting care was on that secret list," he said. "And they wouldn't take you off that secret list until you had an appointment time that was less than 14 days, so that it would give the appearance that they were improving greatly the waiting times, when, in reality, it had been six, nine and in some cases 21 months."

The OIG returned to Phoenix and redoubled its investigation. Veterans organizations held emotional town halls. House and Senate committees convened hearings. More whistle-blowers came forward around the nation. VA Secretary Shinseki ordered audits of the department's more than 900 medical facilities. Obama delivered a ­surprise address on the VA controversy. The OIG not only confirmed Foote's accusations in Phoenix, but also launched probes in at least 42 other VA locations. At least 100 members of Congress demanded Shinseki's ouster.

On Friday, they were appeased.

Foote said he has been stunned by "the enormity of it all."

He added that news coverage exploded in part because some media incorrectly reported the allegation about 40 deaths, saying veterans died because of delays in care. Although anecdotal evidence suggests that may be true, Foote said, he only asserted that veterans died while awaiting care, and the cause remains to be proven.

Regardless, Foote emerged as the iconic whistle-blower in America's angst over health care for veterans. He's appeared on network news, written an op-ed piece for the New York Times and been pictured in the Wall Street Journal, his parents' favorite newspaper. He said his wife and two adult children jokingly refer to him as "#celebritydad."

Amid the hubbub, Foote remains somber about his campaign to expose VA corruption, and he wishes it had not resulted in what he calls "a media circus."

Noting that dedicated colleagues in Phoenix have been threatened, spit at and insulted, he said, "You don't want to generate that kind of animosity at an in­stitution where you spent 24 years of your life trying to help veterans."

He's also reserved about the OIG findings and the ouster of Shinseki. He said he cannot celebrate being vindicated by official findings that veterans have been damaged by delays in care and fraudulent record-keeping. And he suspects that the former VA secretary is a good man who got duped or overmatched by a monolithic bureaucracy.

"I think he had a hard time realizing these people did not have the same moral ethics that he did," Foote added. "But, as they say in the Navy, it happened on his watch."

As for reforming the Phoenix VA Health Care System, Foote is less equanimous.

"As any good surgeon will tell you," he said, "if you've got cancer, you have to cut it all out or it'll come back and kill you."

*Editor's note: This story has been updated to reflect new information about the Congressional response to Foote's complaints.